Search

Jia-Jie Zhong,1 Chia-Hung Tsai,2 Wen-Ying Lee3 1Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan; 2Division of Infectious Disease, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan; 3Department of Pathology, Chi Mei Medical Center, Tainan, TaiwanCorrespondence: Jia-Jie Zhong, Department of Internal Medicine, Chi Mei Medical Center, No. 901, Zhonghua Road, Yongkang Dist, Tainan, Taiwan, Email we1122128@gmail.comAbstract: Herpes simplex virus type 1 (HSV1) pneumonia presents diagnostic challenges due to there being no gold-standard criteria currently. Specimens from bronchoalveolar lavage can increase specificity, and cytohistological examination can prove virus infection. Patients with high viral load have been reported with poor outcomes and benefited from antiviral agent. We describe an 80-year-old man with severe pneumonia who initially showed improvement without antiviral therapy, despite viral inclusion bodies on sputum cytology and positive HSV1 polymerase chain reaction from sputum, though subsequent clinical deterioration due to Pseudomonas aeruginosa infection necessitated intensive care. This case highlights the complexities of diagnosing and managing HSV1 pneumonia, emphasizing the importance of integrating clinical suspicion, radiological imaging, and laboratory tests for timely therapeutic decisions in critically ill patients.Keywords: herpes simplex virus type 1, pneumonia, sputum cytology, polymerase chain reaction, antiviral therapy

Chia-Hung Tsai,1,* Yu-Chin Chen,2,* Po-Yu Chen,3 Chih-Cheng Lai,4,5 Hung-Jen Tang,1 Yin-Ching Chuang,6 Chi-Chung Chen,6,7 Chung-Han Ho,6,8 Wei-Yun Hsu,9,* Tu-Hsuan Chang9,* 1Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan; 2Department of Pediatrics, Chi Mei Medical Center, Chiali, Tainan, Taiwan; 3Department of Nursing, Min-Hwei College of Health Care Management, Tainan, Taiwan; 4Division of Hospital Medicine, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan; 5School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan; 6Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan; 7Department of Food Science, National Chiayi University, Chiayi, Taiwan; 8Department of Information Management, Southern Taiwan University of Science and Technology, Tainan, Taiwan; 9Department of Pediatrics, Chi Mei Medical Center, Tainan, Taiwan*These authors contributed equally to this workCorrespondence: Tu-Hsuan Chang; Wei-Yun Hsu, Department of Pediatrics, Chi Mei Medical Center, Tainan, Taiwan, Tel +886-2-281-2811 Ext 57109, Fax +886-6-220-3706, Email a755115@yahoo.com.tw; wyhsu17@gmail.comPurpose: To investigate the antibiotic susceptibility of Escherichia coli isolates in patients diagnosed with intra-abdominal infections (IAIs) in the Asia-Pacific region.Patients and Methods: This study was conducted at 50 medical hospitals across 9 countries/regions as part of the Study for Monitoring Antimicrobial Resistance Trends (SMART) surveillance program from 2014 to 2018. Nonduplicate isolates of aerobic and facultative gram-negative bacilli were collected and processed for further antimicrobial susceptibility testing.Results: A total of 10,709 isolates were collected, with E. coli (n=4737, 44.2%) being the leading pathogen causing IAIs, followed by Klebsiella pneumoniae (n=2429, 22.7%) and Pseudomonas aeruginosa (n=931, 8.7%). Community-associated (CA) E. coli isolates generally exhibited higher susceptibility rates for most antibiotics than hospital-associated (HA) isolates. In countries/regions other than Hong Kong, South Korea, and Singapore, HA isolates displayed lower susceptibility rates for multiple classes (≥ 4) of antibiotics. Among the commonly used antibiotics in IAIs, the overall susceptibility rate for ciprofloxacin was low, with an average of 41.3%. Ceftriaxone susceptibility rates in all selected countries were below 80% starting in 2018, ranging from 23.3% to 75.8%. The cefepime susceptibility rates varied across regions, with consistently reduced susceptibility ranging from 45.5% to 57.8% in India, Thailand, and Vietnam. Piperacillin/tazobactam demonstrated effectiveness against E. coli isolates in almost all countries except India, with a downward trend observed in the Philippines and Taiwan. Carbapenems remained effective against more than 90% of E. coli isolates, except in India.Conclusion: Prudent use of fluoroquinolones and ceftriaxone is advised when treating both CA and HA IAIs in the Asia-Pacific region. The low susceptibility rate of cefepime in India, Thailand, and Vietnam needs careful consideration in its administration. Moreover, the increase in nonsusceptibility to piperacillin/tazobactam in the Philippines and Taiwan poses a potential risk that should be closely monitored.Keywords: intra-abdominal infection, E. coli, antibiotic susceptibility, Asia-Pacific

Ching-Hua Tsai, Ting-Min Hsieh, Shiun-Yuan Hsu, Ching-Hua Hsieh Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, 83301, TaiwanCorrespondence: Ching-Hua Hsieh, Tel +886-7-7327476, Email m93chinghua@gmail.comIntroduction: The De Ritis ratio, which is the ratio of aspartate aminotransferase (AST) to alanine aminotransferase (ALT), has been suggested as a potential prognostic marker for various diseases. This study aimed to investigate the association between the De Ritis ratio and in-hospital mortality in adult trauma patients.Methods: A total of 17,472 adult trauma patients hospitalized between January 1, 2009, and December 31, 2020, were allocated into groups according to the De Ritis ratio. The normal range of the De Ritis ratio was calculated from 3320 individuals in the National Taiwan Biobank. Statistical analyses were performed using SPSS software.Results: Patients with a De Ritis ratio > 1.6 had a significantly higher in-hospital mortality rate (7.3% vs 1.5%, odds ratio 5.29; Q1–Q3 2.72– 10.30; p < 0.001) and a 2.71-fold higher in-hospital mortality rate (Q1–Q3 1.24– 5.92; p = 0.012), after adjusting for sex, age, comorbidities, consciousness level, and injury severity, than those with a De Ritis ratio within the reference values.Discussion: This study revealed that a De Ritis ratio > 1.6 may serve as an early prognostic tool to identify adult trauma patients at high risk of in-hospital mortality.Keywords: aspartate aminotransferase, AST, alanine aminotransferase, ALT, De Ritis ratio, in-hospital mortality, trauma

Sheng-En Chou,1 Cheng-Shyuan Rau,2 Wei-Ti Su,1 Ching-Hua Tsai,1 Shiun-Yuan Hsu,1 Ching-Hua Hsieh1 1Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; 2Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, TaiwanCorrespondence: Ching-Hua Hsieh, Tel +886-7-7327476, Email m93chinghua@gmail.comIntroduction: The albumin-bilirubin (ALBI) grade objectively assesses liver function with better performance than the Child-Pugh and end-stage liver disease scores. However, the evidence is lacking on the ALBI grade in trauma cases. This study aimed to identify the association between the ALBI grade and mortality outcomes in trauma patients with liver injury.Methods: Data from 259 patients with traumatic liver injury at a level I trauma center between January 1, 2009, and December 31, 2021 were retrospectively analyzed. Independent risk factors for predicting mortality were identified using multiple logistic regression analysis. Participants were characterized by ALBI score into grade 1 (≤ − 2.60, n = 50), grade 2 (− 2.60 < and ≤ − 1.39, n = 180), and grade 3 (> − 1.39, n = 29).Results: Compared to survival (n = 239), death (n = 20) was associated with a significantly lower ALBI score (2.8± 0.4 vs 3.4± 0.7, p < 0.001). The ALBI score was a significant independent risk factor for mortality (OR, 2.79; 95% CI, 1.27– 8.05; p = 0.038). Compared with grade 1 patients, grade 3 patients had a significantly higher mortality rate (24.1% vs 0.0%, p < 0.001) and a longer hospital stay (37.5 days vs 13.5 days, p < 0.001).Discussion: This study showed that ALBI grade is a significant independent risk factor and an useful clinical tool to discover liver injury patients who are more susceptible to death.Keywords: trauma, liver injury, mortality, albumin-bilirubin grade, ALBI grade, liver function

Ming-Jen Tsai,1,&ast; Cheng-Han Tsai,2,3,&ast; Ru-Chiou Pan,4 Chi-Feng Hsu,1 Sheng-Feng Sung5,6 1Department of Emergency Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan; 2Department of Emergency Medicine, Chiayi Branch, Taichung Veteran’s General Hospital, Chiayi City, Taiwan; 3Department of Information Management, Institute of Healthcare Information Management, National Chung Cheng University, Chiayi County, Taiwan; 4Clinical Data Center, Department of Medical Research, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan; 5Division of Neurology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan; 6Department of Nursing, Min-Hwei Junior College of Health Care Management, Tainan, Taiwan&ast;These authors contributed equally to this workCorrespondence: Sheng-Feng Sung, Division of Neurology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan, Tel +886 5 276 5041 Ext 7283, Fax +886 5 278 4257, Email sfusng@cych.org.tw; richard.sfsung@gmail.comPurpose: Taiwan’s national health insurance (NHI) database is a valuable resource for large-scale epidemiological and long-term survival research for out-of-hospital cardiac arrest (OHCA). We developed and validated case definition algorithms for OHCA based on the International Classification of Diseases (ICD) diagnostic codes and billing codes for NHI reimbursement.Patients and Methods: Claims data and medical records of all emergency department visits from 2010 to 2020 were retrieved from the hospital’s research-based database. Death-related diagnostic codes and keywords were used to identify potential OHCA cases, which were ascertained by chart reviews. We tested the performance of the developed OHCA algorithms and validated them on an external dataset.Results: The algorithm defining OHCA as any cardiac arrest (CA)-related ICD code in the first three diagnosis fields performed the best with a sensitivity of 89.5% (95% confidence interval [CI], 88.2– 90.7%), a positive predictive value (PPV) of 90.6% (95% CI, 89.4– 91.8%), and a kappa value of 0.900 (95% CI, 0.891– 0.909). The second-best algorithm consists of any CA-related ICD code in any diagnosis field with a billing code for triage acuity level 1, achieving a sensitivity of 85.6% (95% CI, 84.1– 87.0%), a PPV of 93.6% (95% CI, 92.5– 94.5), and a kappa value of 0.894 (95% CI, 0.884– 0.903). Both algorithms performed well in external validation. In subgroup analyses, the former algorithm performed the best in adult patients, outpatient claims, and during the ICD-9 era. The latter algorithm performed the best in the inpatient claims and during the ICD-10 era. The best algorithm for identifying pediatric OHCAs was any CA-related ICD code in the first three diagnosis fields with a billing code for triage acuity level 1.Conclusion: Our results may serve as a reference for future OHCA studies using the Taiwan NHI database.Keywords: administrative claims data, diagnosis, ICD-9-CM, ICD-10-CM, out-of-hospital cardiac arrest, validation

Wei-Ti Su,1 Ching-Hua Tsai,1 Chun-Ying Huang,1 Sheng-En Chou,1 Chi Li,1 Shiun-Yuan Hsu,1 Ching-Hua Hsieh2 1Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; 2Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, TaiwanCorrespondence: Ching-Hua HsiehDepartment of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No. 123, Ta-Pei Road, Niao-Song District, Kaohsiung City, 833, TaiwanTel +886-7-7327476Email m93chinghua@gmail.comBackground: The Geriatric Nutritional Risk Index (GNRI) is a simple and objective screening tool for clinicians to screen patients’ nutritional status based on serum albumin level and their weight and height. The original study had divided patients based on GNRI into quartiles of nutritional risk for death: a no-risk group (GNRI > 98), a low-risk group (GNRI 92– 98), a moderate-risk group (GNRI 82 to < 92), and a major-risk group (GNRI < 82). Given that the patients generally sustained traumatic brain injury (TBI) in an acute condition, the study aimed to explore whether GNRI presents a prognostic value for the mortality outcome of these patients.Methods: From January 1, 2009, to December 31, 2019, 581 elderly patients with moderate to severe TBI, which was defined as sustaining a head Abbreviated Injury Scale ≥ 3, was included in the study population. The collected data included age, sex, body mass index, serum albumin levels at admission, preexisting comorbidities, Glasgow Coma Scale, and Injury Severity Score. The primary outcome in the comparison was in-hospital mortality.Results: Multivariate logistic regression analysis revealed that GNRI, ESRD, and ISS were significant independent risk factors for mortality in patients with moderate to severe TBI. When subgrouping the study population into four nutritional risk categories according to the quartile deviation as Q1 (GNRI < 85, n = 145), Q2 (GNRI 85 to < 93.8 n = 145), Q3 (GNRI 93.8 to 103, n = 145), and Q4 (GNRI > 103, n = 146), Q1 patients had a significantly longer LOS in hospital (25.2 days vs 18.6 days, respectively; p = 0.004) and higher mortality rate (28.3% vs 11.7%, respectively; p < 0.001) than Q4 patients. The mortality rate was significantly higher in Q1 patients than in Q4 patients (OR, 2.8; 95% CI, 1.14– 6.78; p = 0.021).Conclusion: This study revealed that the GNRI is a significant independent risk factor and a promising simple assessment tool for mortality in elderly patients with moderate to severe TBI.Keywords: elderly, malnutrition, mortality, Geriatric Nutritional Risk Index, GNRI, trauma, traumatic brain injury, TBI

Chen-Lin Kang,1– 3 Tsair-Fwu Lee,1,4,5 Shan-Ho Chan,2 Shyh-Chang Liu,3 Jui-Chu Wang,6 Cheng-Hsiang Tsai,1 Kuan-Cho Liao,1 Fu-Min Fang,1 Liyun Chang,7 Chun-Chieh Huang1,8 1Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; 2Department of Medical Imaging and Radiology, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan; 3Department of Information Engineering, I-Shou University, Kaohsiung, Taiwan; 4Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Science and Technology, Kaohsiung, Taiwan; 5Biomedical Engineering, Kaohsiung Medical University, Kaohsiung, Taiwan; 6Department of Anatomical Pathology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; 7Department of Medical Imaging and Radiological Sciences, I-Shou University, Kaohsiung, Taiwan; 8Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, TaiwanCorrespondence: Chun-Chieh HuangDepartment of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital, No 123, Dapi Road, Niaosong Dist., Kaohsiung 833, TaiwanTel +886 9 75056110Fax +886 7 7322813Email cgukinace@gmail.comPurpose: Maintaining immobilization to minimize spine motion is very important during salvage stereotactic ablative radiation therapy (SABR) for recurrent head and neck cancer. This study aimed to compare the intrafractional motion between two immobilization methods.Patients and Methods: With a spine tracking system for image guiding, 9094 records from 41 patients receiving SABR by CyberKnife were obtained for retrospective comparison. Twenty-one patients were immobilized with a thermoplastic mask and headrest (Group A), and another 20 patients used a thermoplastic mask and headrest together with a vacuum bag to support the head and neck area (Group B). The intrafractional motion in the X (superior-inferior), Y (right-left), Z (anterior-posterior) axes, 3D (three-dimensional) vector, Roll, Pitch and Yaw in the two groups was compared. The margins of the planning target volume (PTV) to cover 95% intrafractional motion were evaluated.Results: The translational movements in the X-axis, Y-axis, and 3D vector in Group A were significantly smaller than in Group B. The rotational errors in the Roll and Yaw in Group A were also significantly smaller than those in Group B; conversely, those in the Pitch in Group A were larger. To cover 95% intrafractional motion, margins of 0.96, 1.55, and 1.51 mm in the X, Y and Z axes, respectively were needed in Group A, and 1.06, 2.86, and 1.34 mm, respectively were required in Group B.Conclusion: The immobilization method of thermoplastic mask and head rest with vacuum bag did not provide better immobilization than that without vacuum bag in most axes. The clinical use of 2 mm as a margin of PTV to cover 95% intrafractional motion was adequate in Group A but not in Group B.Keywords: stereotactic ablative radiation therapy, CyberKnife, intrafractional motion, immobilization method, head and neck cancer

Chien-Fu Yeh,1–3,* Tung‐Yueh Chuang,4,* Yu-Wen Hung,5 Ming-Ying Lan,2,3 Ching-Han Tsai,4 Hao-Xiang Huang,4 Yung-Yang Lin1,4,6–8 1Institute of Brain Science, National Yang-Ming University, Taipei 11221, Taiwan; 2Department of Otorhinolaryngology, National Yang-Ming University, Taipei 11221, Taiwan; 3Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei 11217, Taiwan; 4Department of Critical Care Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; 5Institute of Cellular and System Medicine, National Health Research Institutes, Miaoli County 35053, Taiwan; 6Institute of Physiology, National Yang-Ming University, Taipei 11221, Taiwan; 7Institute of Clinical Medicine, National Yang-Ming University, Taipei 11221, Taiwan; 8Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei 11217, Taiwan*These authors contributed equally to this workCorrespondence: Yung-Yang LinDepartment of Critical Care Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Taipei 11217, TaiwanTel +886-2-2871-2121Fax +886-2-2875-7890Email g2000kev@gmail.comBackground: Ischemic stroke triggers inflammatory responses and oxidative stress in the brain, and microglia polarization affects the degree of neuroinflammation. It has been reported that the inhibition of soluble epoxide hydrolase (sEH) activity protects brain tissue. However, the anti-inflammatory and antioxidative effects of sEH inhibition in the ischemic brain are not fully understood. This study aimed to investigate the effects of a selective sEH inhibitor, 12-(3-adamantan-1-yl-ureido)-dodecanoic acid (AUDA), after ischemic stroke.Methods: Adult male rats with middle cerebral artery occlusion (MCAO) were administered with AUDA or a vehicle. Behavioral outcome, infarct volume, microglia polarization, and gene expression were assessed.Results: Rats treated with AUDA showed better behavioral outcomes and smaller infarct volumes after MCAO. After AUDA treatment, a reduction of M1 microglia and an increase of M2 microglia occurred at the ischemic cortex of rats. Additionally, there was an increase in the mRNA expressions of antioxidant enzymes and anti-inflammatory interleukin-10, and pro-inflammatory mediators were decreased after AUDA administration. Heme oxygenase-1 was mainly expressed by neurons, and AUDA was found to improve the survival of neurons.Conclusion: The results of this study provided novel and significant insights into how AUDA can improve outcomes and modulate inflammation and oxidative stress after ischemic stroke.Keywords: ischemic stroke, microglia polarization, middle cerebral artery occlusion, soluble epoxide hydrolase, anti-inflammation, antioxidant

Chi-Wen Chou,1,2 Ya-Wen Cheng,3 Chung-Hung Tsai1 1Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; 2Department of Orthopedics Surgery, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan; 3Graduate Institute of Cancer Biology and Drug Discovery, College of Medical Science and Technology, Taipei Medical University, Taipei, TaiwanObjective: Bamboo is distributed worldwide, and its different parts are used as foods or as a traditional herb. Recently, antitumoral effects of bamboo extracts on several tumors have been increasingly reported; however, antitumoral activity of bamboo extracts on osteosarcoma remains unclear. In the present study, we investigated effects of an aqueous Phyllostachys edulis leaf extract (PEE) on osteosarcoma cells and the underlying mechanism of inhibition. Methods: The growth of human osteosarcoma cell lines 143B and MG-63 and lung fibroblast MRC-5 cells was determined by MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) assay. Apoptosis was demonstrated using TUNEL (terminal deoxynucleotidyl transferase dUTP nick end labeling) assay and flow cytometric analysis. Phosphorylation and protein levels were determined by immunoblotting. Results: After treatment with PEE, viability of 143B and MG-63 cells was dose-dependently reduced to 36.3%±1.6% of control values, which were similar to AICAR (5-aminoimidazole-4-carboxamide 1-β-D-ribofuranoside) treatments. In parallel, ratios of apoptotic cells and cells in the sub-G1 phase were significantly increased. Further investigation showed that PEE treatments led to activation of caspase cascades and changes of apoptotic mediators Bcl2, Bax, and p53. Consistently, our results revealed that PEE activated adenosine monophosphate-activated protein kinase (AMPK) signaling, and the AMPK activation was associated with the induction of apoptotic signaling. Conclusion: Our results indicated that PEE suppressed the growth of 143B and MG-63 cells but moderately affected MRC-5 cells. PEE-induced apoptosis may attribute to AMPK activation and the following activation of apoptotic signaling cascades. These findings revealed that PEE possesses antitumoral activity on human osteosarcoma cells by manipulating AMPK signaling, suggesting that PEE alone or combined with regular antitumor drugs may be beneficial as osteosarcoma treatments.Keywords: bamboo, antitumor, AMPK, Bcl2, Bax

Aims: The study aims were to determine autoantibodies associated with type 1 diabetes (T1D), celiac disease (CD) and autoimmune thyroid disease (AITD) in individuals living with type 2 diabetes (T2D) compared to T1D and matched controls. Methods: Individuals with T1D and T2D were randomly identified in health-care registers. Blood was collected through home-capillary sampling and autoantibodies associated with either T1D against glutamic acid decarboxylase (GADA), insulin (IAA), insulinoma antigen-2 (IA-2A), and zinc transporter 8 (ZnT8A), CD against tissue transglutaminase (tTGA) or AITD against thyroid peroxidase (TPOA) were determined in an automated, multiplex Antibody Detection by Agglutination-PCR (ADAP) assay. Results: GADA were detected in 46 % (88/191) of T1D and increased to 6.2 % (23/372) in T2D compared to 2.6 % (7/259) of controls (p = 0.0367). tTGA was low (1.1–2.6 %) and not different in between the study cohorts, nonetheless, in T1D tTGA was associated to islet autoantibodies. TPOA was more frequent in T1D, 27.1 % (53/191), compared to either T2D, 14.8 % (55/372; p = 0.0002) or controls, 14.3 % (37/259) (p = 0.0004). Overall, TPOA was more frequent in GADA positive (34.8 %; 8/23) than negative (13.5 %; 47/349; p = 0.0053) T2D individuals. Conclusion: It’s suggested that analyzing GADA and TPOA may refine the autoimmune landscape in individuals clinically classified as T2D.

Maritime Autonomous Surface Ships (MASS) have brought a transformative wave in the marine industry, yielding unprecedented operational advancements and efficiency gains. However, this paradigm shift has concurrently raised substantial cybersecurity concerns that demand meticulous attention to mitigate the impact of attacks on MASS stability. This study presents a comprehensive examination of the cybersecurity landscape, shedding light on prevalent issues concerning the data independence, integrity, and connectivity of MASS. The effectiveness of existing defense strategies against both inbound and outbound cyberattacks, focusing on attack detection and classification, is rigorously scrutinized. This analysis encompasses regulatory frameworks, encryption methods, intrusion detection systems, and a systematic approach to identifying and categorizing cyber threats. Additionally, the study anticipates future developments in cyber threats and proposes innovative solutions to fortify MASS defenses against potential cybersecurity vulnerabilities. To align with cybersecurity standards, this paper integrates challenges, possible solutions, and future advancements in a structured and cohesive manner, ensuring a thorough understanding of the intricate cybersecurity ecosystem surrounding Maritime Autonomous Surface Ships.

Aims: The objective was to compare anxiety, depression, and quality of life (QoL) in individuals living with type 1 (T1D) and type 2 (T2D) diabetes with matched controls during the second wave of the COVID-19 pandemic. Methods: Via randomization, individuals living with diabetes T1D (n = 203) and T2D (n = 413), were identified during February-July 2021 through health-care registers. Population controls (n = 282) were matched for age, gender, and residential area. Questionnaires included self-assessment of anxiety, depression, QoL, and demographics in relation to SARS-CoV-2 exposure. Blood was collected through home-capillary sampling, and SARS-CoV-2 Nucleocapsid (NCP) and Spike antibodies (SC2_S1) were determined by multiplex Antibody Detection by Agglutination-PCR (ADAP) assays. Results: Younger age and health issues were related to anxiety, depression, and QoL, with no differences between the study groups. Female gender was associated with anxiety, while obesity was associated with lower QoL. The SARS‑CoV‑2 NCP seroprevalence was higher in T1D (8.9 %) compared to T2D (3.9 %) and controls (4.0 %), while the SARS‑CoV‑2 SC2_S1 seroprevalence was higher for controls (25.5 %) compared to T1D (16.8 %) and T2D (14.0 %). Conclusions: A higher SARS‑CoV‑2 infection rate in T1D may be explained by younger age and higher employment rate, and the associated increased risk for viral exposure.

Abstract The occurrence of gastrointestinal metastasis from lung carcinoma is rare. Compared with non‐small cell lung cancer (NSCLC), small cell lung cancer more commonly results in this sort of metastasis. Here, we report an unusual case of NSCLC initially without evidence of distant metastasis that developed into gastric metastasis five months after the initial diagnosis, despite the primary lung cancer having a partial response to radiotherapy and chemotherapy. Serial radiological examinations and endoscopic biopsies of the gastric tumor confirmed that it was a metastatic carcinoma originating from the lung. The patient received a total gastrectomy for gastric metastasis due to repeated gastrointestinal bleeding.

Welding and relevant studies are indispensable to employ high-entropy alloys for practical applications. In this study, Al0.3CoCrCu0.3FeNi high-entropy alloy with single FCC phase was used to make “bead-on-plate” friction stir welds at different rotational speeds, and the effects on microstructure and mechanical properties were studied. Several banded structures containing oxide or nitride particles were observed in the stir zone (SZ), and the chemical wear of the polycrystalline cubic boron nitride tool was confirmed. The microhardness distribution of the welds showed higher hardness in the SZ because of grain refinement and the presence of deformed grains. The electron backscattered diffraction results suggested that the high-entropy alloy with low stacking-fault energy experienced recrystallization during friction stir welding, which was similar to other conventional materials with low stacking-fault energy.